Reliability of Suicide Risk Estimates: A Vignette Study.

Objective: Suicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes.

Method: In total, N = 256 participants (psychology students, psychotherapists) were presented with 24 case vignettes describing patients at either low, moderate, severe or extreme risk of suicide. Participants were asked to assign a level of risk to each single vignette at a baseline assessment and again at a follow-up assessment two weeks later.

Results: Risk estimates showed a low inter-rater reliability, both for students (AC₁ = .35) and for psychotherapists (AC₁ = .44). Intra-rater reliability was moderate for psychotherapists (AC₁ = .59) and rather low for psychology students (AC₁ = .47). In general, intra- and intra-rater reliability were highest for vignettes displaying "low" and "extreme" risk.

Conclusions: The results highlight that the reliability of unguided suicide risk assessments is questionable. Standardized risk assessment protocols are therefore recommended. Nonetheless, even reliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.